PURPOSE: Despite recent progress in the procedures of revascularization, acute limb ischemia continues to account for a wide variety of complications, culminating very often in limb loss or death. These poor results after treatment of acute limb ischemia still remains a major challenge in vascular surgery. METHOD: To evaluate the clinical characteristics and risk factors for early limb loss in acute limb ischemia, the clinical data of 87 limbs (8 upper and 79 lower limbs) in 83 patients. that underwent revascularization for acute limb ischemia at Yeungnam University Hospital from January 1995 to February 2003 were analyzed retrospectively. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects predictive of amputation free survival. RESULT: The patients, 78 males and 9 females, ranged from 30 to 83 years of age, with a mean age of 67. The highest incidence occurred among people in their 50s and 60s. The underlying causes of acute limb ischemia were arterial embolism in 42 limbs (42/87, 48.2%), arterial thrombosis in 36 (36/87, 41.3%), bypass graft occlusion in 9 (9/87, 10.3%). The primary sources of embolism were cardiac origin in 25 cases (25/42, 59.5%), aneurysmal origin in 2 (2/42, 4.8%) and unknown origin in 15 (15/42, 35.7%). As for the severity of ischemia according to SVS/ISCVS classification, 40 limbs (40/87, 46.0%) were classified as category IIa, 39 (39/87, 44.8%) as category IIb, and 8 (8/87, 9.2%) as category III. For the treatment, 66 thromboembolectomies (including 20 cases treated with intraoperative thrombolytic therapy), 19 arterial bypasses and 2 catheter directed thrombolytic therapies were performed. There were 13 major amputations and 8 mortalities at 6 months after revascularization. Cumulative 15 day, and 1, 2, 4, and 6-month amputation-free survival rate of all survival patients were 88.8%, 85.7%, 83.9%, 83.9% and 81.4% respectively. Among the univariate analysis of 26 clinical variables, 10 factors were identified as being associated with amputation-free surviva: age (P=0.01), preoperative tissue gangrene (P=0.03), preoperative skin color change (P=0.00), preoperative muscle status (P=0.00), preoperative motor and sensory deficit (P=0.00, P=0.00), severity of ischemia by clinical category (P=0.00), symptom duration (P=0.02), length of occlusion (P=0.01), and cause of occlusion (P=0.01). In multivariate analysis, age (P=0.04), and preoperative skin color change (P=0.00) predicted a poorer response to therapy. The major limb amputations were performed in 2 limbs (2/41, 4.9%) of the emboli group, and 11 limbs (11/42, 26.2%) of the thrombi group. For the limb with thrombosis, the major limb amputations were performed in 9 limbs (9/26, 34.6%) of the thromboembolectomy group and in 2 limbs (2/16, 1.3%) of the arterial bypass group. CONCLUSION: These results suggest that prompt and appropriate treatment is critically important in the management of acute limb ischemia. In thrombi cases Especially, a more aggressive surgical approach may be necessary for limb salvage.
Amputation ; Aneurysm ; Catheters ; Classification ; Embolism ; Extremities* ; Female ; Gangrene ; Humans ; Incidence ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Skin ; Survival Rate ; Thrombolytic Therapy ; Thrombosis ; Transplants

In the treatment of this complicated diabetic foot patient, we need an effective treatment principle because the complicated diabetic foot patient needs a longer hospitalization period and suffers from more frequent recurrences. We reviewed 43 diabetic foot patients who were treated in our department during the past 4 years. The 43 patients were divided into 4 groups according to their combined complications. Group A was the simple diabetic foot group(no complication group, n = 17). Group B was the diabetic foot group combined with the extensive cellulitis(n = 9). Group C was the diabetic foot group combined with the peripheral vascular disease(n = 8). Group D was the diabetic foot group combined with the renal failure(n = 9). As a results, wide range of reconstructive methods can be selected in the simple diabetic foot group. In group B, early and wide debridement was important to control the infection and later flap reconstruction was appropriate. In group C, the bypass operation should be desperate before improving the circulation of lower extremities, and therefore we successfully reconstructed the foot with various metohds including plantar V-Y advancement flap, considered as the most useful in our series. In group D, recurrence was more frequent and lower extremity amputations above the ankle level couldn't be avoided in spite of many operations and longer hospitalization. Therefore consideration of early amputaiotn is recommended for the effective treatment of this group.
Amputation ; Ankle ; Debridement ; Diabetic Foot* ; Foot ; Hospitalization ; Humans ; Lower Extremity ; Peripheral Vascular Diseases* ; Recurrence ; Renal Insufficiency*

Nesidioblastosis is a term that describes the prolonged differentiation of the Langerhan's islet cells from the epithelium of the pancreatic duct. Islet cell lesions accompanied with hyperinsulinemic, 80% are found to be benign islet cell tumors. In additional 10% are malignant and the remaining are nesidioblastosis. Children are usually affected and develop hyperinsulinemic hypoglycemia, but it is rare in adults. Only 20 cases has been reported worldwide and 6 cases in Korea. A 41-year old man & 42-year old woman was admitted due to intermittent hypoglycemic symptoms, that had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during prolonged fasting. Under the presumptive diagnosis of insulinoma, Abdominal CT, Celiac angiogram and percutaneous transhepatic portal venous sampling were done, but we could not find any definitive mass. 85% of the pancreas & 88% of the pancreas was removed respectively. Pathologic examination of the resected pancreas revealed irregularly sized islets and scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex.
Adenoma, Islet Cell ; Adult* ; Child ; Diagnosis ; Eating ; Endocrine Cells ; Epithelium ; Fasting ; Female ; Humans ; Hypoglycemia ; Insulinoma ; Islets of Langerhans ; Korea ; Nesidioblastosis* ; Pancreas ; Pancreatic Ducts ; Tomography, X-Ray Computed

A lymphangionma is a rare benign tumor occuring in the gastrointestinal tract, which is composed of lymphatic vessels of various size. A sharply demarcated smooth, soft, cystic submucosal tumor which is easily compressible and covered with normal mucosa is a characteristic ally an endoscopic feature. This lesion is considered to be a benign lesion, which does not need to be treated, but in cases that involve risk of any complications or symptoms, the lesion needs to be removed. Servral endoscopic treatment methods for a symptomatic lymphangioma have been introduced, but accompanying risk of complications, such as bleeding or perforation were reported. As complete removal of a lymphangioma is impossible due to its broad base, a newly developed unroofing method is presented to be effective and safe for resection of a large lymphan-gioma. Recently, 2 cases were experienced involving a lymphangioma in the large intestine, which was removed successfully by colonscopic unroofing therapy.
Colon* ; Colonoscopy ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Large ; Lymphangioma* ; Lymphatic Vessels ; Mucous Membrane

Antibiotics related colitis is a well recognized disease entity which in its severest form may result in pseudomembranous colitis, whereas in another form, acute hemorrhagic colitis without pseudomembrane, related to the use of penicillin-type antibiotics is rarely reported. The clinical features of hemorrhagic colitis associated with antibiotics was characterized that the bloody diarrhea, often with abdominal cramping pain begins 2~7 days after starting the antibiotics and rapidly recovered after its withdrawal. Pathogenesis of this disease is not entirely clear. It has been believed that right-sided hemorrhagic colitis is one of the main forms of colitis associated with antibiotics, especially ampicillin derivatives or cephalosporin, but recent reports presented left-sided colitis. We experienced 2 cases of hemorrhagic colitis developed on the left colon after the introduction of quinolone.
Ampicillin ; Anti-Bacterial Agents* ; Colic ; Colitis* ; Colon ; Diarrhea ; Enterocolitis, Pseudomembranous

PURPOSE: The present study was designed to investigate rotavirus infection by comparing clinical characteristics of the nosocomial infection of rotavirus between preterm and full-term neonates. METHODS: The subjects were admitted from May to December, 1996. In 71 preterms, 44 were Rotazyme positive, 27 were negative, and in 321 full-terms, 64 were Rotazyme positive, 257 were negative. We studied the rate of positive Rotazyme ELISA test and positive symptoms. We compared clinical manifestations and parameters between both groups. Stools were examined with occult blood, stool culture and Rotazyme ELISA tests. RESULTS: The rate of nosocomial rotavirus infection in neonates was 27.6% and increased as the neonates matured. Rotazyme positive rate is not significantly related to sex, birth weight and symptoms with necrotizing enterocolitis(NEC) between preterm and full-term neonates. But, jaundice developed more frequently in Rotazyme positive groups. When the neonates matured, they had longer durations of positive symptoms and positive Rotazyme tests. Also they had shorter onset times of positive symptoms and positive Rotazyme tests. Positive symptoms rate was 74.0% in total, 95.5% in preterm and 59.4% in full-term. Abdominal distension, jaundice and NEC increased significantly in preterms. CONCLUSION: Rotavirus can be a significant pathogen in preterms more than in full-terms. Neonates suffering from suspected sepsis should be investigated for rotaviral infection. A new oral vaccine and oral immunoglobulin is needed for eradicating rotavirus infection in the nursery. Further studies about isolations, infection pathways, immune responses and treatment of rotavirus are needed.
Birth Weight ; Cross Infection* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulins ; Infant, Newborn* ; Jaundice ; Nurseries ; Occult Blood ; Rotavirus Infections ; Rotavirus* ; Sepsis

BACKGROUND: Human keratinocyte growth factor(KGF) is an epithelial cell specific mitogen which is secreted by normal stromal fibroblast. In skin, KGF has been shown to stimulate keratinocyte proliferation. OBJECTIVE: In the present study, we sought to determine whether KGF is expressed in human squamous and basal cell carcinoma. METHODS: Using a reverse transcriptase polymerase chain reaction(RT-PCR), we examined the expression of KGF mRNA in normal and cancerous human skin tissues. RESULTS: 1. The 583 bp KGF specific PCR product was observed in normal human cultured fibroblast, but no PCR product was seen in normal human cultured keratinocyte, A431, PAM212, HaCaT, and XB2 cell lines by RT-PCR of KGF mRNA using KGF-specific primer as visualized on an ethidium bromide stained agarose gel. 2. The 583 bp KGF specific PCR product was observed in the normal human dermis, squamous and basal cell carcinoma samples. 3. All three squamous and basal cell carcinoma samples revealed significant overexpression of KGF mRNA transcript in comparison with normal skin tissue. CONCLUSION: These results suggest that KGF mRNA level may be elevated in squamous and basal cell carcinoma and elevated KGF may enhance cellular proliferation of these skin carcinoma.
Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell* ; Cell Line ; Cell Proliferation ; Dermis ; Epithelial Cells ; Ethidium ; Fibroblast Growth Factor 7* ; Fibroblasts ; Humans ; Keratinocytes* ; Polymerase Chain Reaction ; RNA, Messenger* ; RNA-Directed DNA Polymerase ; Sepharose ; Skin

BACKGROUND: It is well known that patients with atopic dermatitis are prone to cutaneous infections, and especially superficial fungal infection. However, a study on the relationship of superficial fungal infection in atopic dermatitis patients has not yet been performed in Korea. OBJECTIVE: The purpose of this study is to evaluate the relationship of atopic dermatitis to superficial fungal infection in Koreans. METHODS: We examined for evidence of superficial fungal disease in 2,153 atopic dermatitis patients and we compared the findings to those of 126,777 non-atopic dermatitis patients who visited the Department of Dermatology of Chung-Ang University from January 2003 to December 2007. RESULTS: Superficial fungal infections were more common in the atopic dermatitis patients (6%) than in the controls (2.5%) (p<0.05) and especially in the age group of the 1st and 2nd decades (p<0.05). The seasonal prevalence of superficial fungal infection was high during summer for both groups (38% vs 44%, respectively). The most common site of fungal distribution was feet (Tinea pedis) for both groups (42.5% vs 28.1%, respectively). The prevalence of coexisting superficial fungal infection was not significantly different in both groups (38.3% vs 39.9%, respectively). The most common isolated organism was Trichophyton rubrum in both groups (52.7% vs 38%, respectively). CONCLUSION: The study shows that the prevalence of superficial fungal infection in atopic dermatitis patients is higher than that in controls. Therefore, we should consider the presence of combined superficial fungal infection in recalcitrant atopic dermatitis patients and use antifungal agents for treatment.
Antifungal Agents ; Dermatitis ; Dermatitis, Atopic ; Dermatology ; Foot ; Humans ; Korea ; Prevalence ; Seasons ; Trichophyton

PURPOSE: Enterobacter is one of the important organisms in neonatal intensive care unit. We reviewed the clinical characteristics, underlying diseases, invasive procedures during admission, mortality and antibiotic sensitivity of Enterobacter infection in NICU. METHODS: We retrospectively reviewed 21 neonatal patients whose blood cultures yielded Enterobacter between June 1994 and June 1997 at Dongguk University Hospital. RESULTS: Blood cultures were positive in 62 from 2,025 neonates and 21 was Enterobacter. The clinical spectrums were diverse such as sepsis (85%), pneumonia, disseminated intravascular coagulopathy and necrotizing enterocolitis. The underlying conditions upon admission were composed of prematurity (38%), hyaline membrane disease (38%), jaundice, sepsis and pneumonia. The procedures used during admission were endotracheal intubation (57%), mechanical ventilation (57%), umbilical vessel catheterization, gastric tube inserition, total parenteral nutrition and exchange transfusion. The antibiotic sensitivity was as follows : ampicillin (0%), ceftriaxone (0%), amikacin (55%), gentamicin (85%), ciprofloxacin (100%), imipenem (100%). Overall mortality was 26.5%. Mortality was significantly high in cases of leukopenia (P< or = 0.01), thrombocytopenia (P< or = 0.01) and use of inappropriate antibiotics (P< or = 0.01). CONCLUSION: Enterobacter is an important organism in the cause of nosocomial infection in NICU and has a high rate of mortality. Enterobacter infection was associated with prolonged hospitalization, invasive procedures and preceding antibiotics. Commonly used antibiotics such as penicillin and cephalosporin would be inappropriate for the treatment of Enterobacter infection. We consider the use of gentamicin or imipenem to be far more effective in the initial therapy of Enterobacter infection.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia* ; Catheterization ; Catheters ; Ceftriaxone ; Ciprofloxacin ; Cross Infection ; Enterobacter* ; Enterocolitis, Necrotizing ; Gentamicins ; Hospitalization ; Humans ; Hyaline Membrane Disease ; Imipenem ; Infant, Newborn ; Intensive Care, Neonatal* ; Intubation, Intratracheal ; Jaundice ; Leukopenia ; Mortality ; Parenteral Nutrition, Total ; Penicillins ; Pneumonia ; Respiration, Artificial ; Retrospective Studies* ; Sepsis ; Thrombocytopenia

Colorectal cancer(CRC) is the most common gastrointestinal malignancy in the Western world. The total number of CRC cases in Korea is increasing probably due to western-style diets. CRC is relatively uncommon in the young adult group. Nevertheless, these cases warrant special attention because they are often diagnosed in an advanced stage and are more likely to involve a family history of CRC. Controversies still exist over the determination of the age range and over the true value of age factor in the prognosis for the young adults. The aim of this study is to calculate the incidence, to evaluate the clinicopathologic characteristics and the outcome of management of young adult with CRC. A retrospective review of 864 patients with an adenocarcinoma of the colon or rectum, who were surgically treated and followed-up in our Department of the Kang Buk Samsung Hospital, Sung Kwun Kwan University College of Medicine, Seoul, Korea, between January 1970 and December 1995 was performed. Among these patients, 138 were in the young adult group, aged less than 40. All cases accompanied by familial adenomatous polyposis coli and ulcerative colitis were excluded. Young adults accounted for 16.0% of all patients with CRC, showing no significant sex difference compared with the control group. The rectum and sigmoid colon were the most frequent sites of the lesion (80.4%). The incidences of Dukes' stage C and poorly differenciated adenocarcinoma cases were significantly higher in the young adult group (p<0.05). The curative resection rate of tumors in young patients was 93.4%. Despite of the more advanced stage and poorly differenciation, the stage-related and overall 5-year survival rate was not significantly different between old and young patients (57.9% and 59.4% in young and old patients, respectively). CRC in young adults in Korea is increasing in number, but its proportion is decreasing. The results of our study indicate that the prognosis and the stage-related survival for CRC in young adults are not related to age.
Adenocarcinoma ; Adenomatous Polyposis Coli ; Age Factors ; Colitis, Ulcerative ; Colon ; Colon, Sigmoid ; Colorectal Neoplasms* ; Diet ; Humans ; Incidence ; Korea ; Prognosis ; Rectum ; Retrospective Studies ; Seoul ; Sex Characteristics ; Survival Rate ; Western World ; Young Adult*